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Reduced Hospital and Emergency Room Utilization Leads to Cost Savings

Tailoring support to an individual's level of activation and self-management ability allows coaches to address the competencies that drive the behaviors critical to better health and the more efficient use of healthcare resources

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People with chronic health conditions who receive coaching tailored to their level of health activation showed significant improvements in clinical outcomes, and experienced fewer hospitalizations and visits to the emergency room than those coached using traditional methods, according to a study published in the June issue of The American Journal of Managed Care.

The study, led by Judith Hibbard, Ph.D. and colleagues at the University of Oregon, compared the behaviors of patients receiving standard telephone disease management (DM) coaching with those who received more tailored coaching based on their "activation level" as part of a DM program offered by the health improvement company LifeMasters Supported SelfCare, Inc. Activation levels are determined by the Patient Activation Measure™ (PAM™), a survey tool developed by Hibbard and colleagues to assess an individual's knowledge, skills and confidence in playing a role in one's own health and healthcare.

"LifeMasters is continually implementing new methodologies and tools to improve outcomes," said Mary Jane Osmick, M.D., Vice President and Medical Director. "We have learned that deploying targeted interventions rather than using a 'one size fits all' approach is a critical success factor. Our nurses and coaches are the first in the DM industry to provide individual patient support by applying a fully integrated coaching model that includes the PAM. The findings reinforce our understanding that improved activation is an overarching measure of success that leads to significant clinical improvement and financial savings. "

The quasi-experimental research, which was conducted in a real-life DM setting, included an intervention group and a control group of nurse coaches and their patients in geographically separate call centers, which were selected based on the similarity of their nurse coaches' tenure and years of experience.

The findings show those who received coaching with the PAM experienced a 33% decline in hospital admissions compared to the control group, which remained flat, and a 22% decline in emergency room visits compared with an increase of 20% in the control group. The PAM group also experienced statistically significant improvements in diastolic blood pressure and in LDL cholesterol levels relative to the control group, and increased their adherence to recommended immunization and drug regimens, including the influenza vaccine.

The PAM score intervention group showed fewer hospital stays, which translated into a savings of $145 per person per month for the intervention population. A similar decline was seen in visits to the emergency room among this group, which equates to an $11 per person per month savings.

"The PAM is unique among social science-based assessments in that it measures an individual's underlying health belief structure. This structure reflects the degree to which the person feels in charge of his or her own health and healthcare, and is the basis for a whole spectrum of health behaviors. This creates a more holistic view of the individual, one which is essential to providing effective support," said Dr. Hibbard.

The Patient Activation Measure, which is licensed and marketed by Insignia Health , consists of a 10 or 13-question survey that asks people about their beliefs, knowledge, skills and confidence for engaging in a wide range of health behaviors. Based on responses to the survey, each person is assigned an activation score and level. The PAM segments participants into one of four progressively higher activation levels.

At the low end of the spectrum, individuals tend to be passive in managing their health, and may fail to see the connection between their own behaviors and health outcomes. At the high end, individuals understand that relationship and have become good self-managers across a constellation of behaviors. However, even high activation level individuals show opportunities to improve and can benefit from coaching to help them stay on course in times of stress or change to their routine.

More than 85 studies have documented the PAM's ability to effectively measure patient activation and to predict a range of behaviors in wide demographic and socioeconomic variability. Research has shown that higher levels of activation rates correlate with improved self-care behaviors. In fact, the Hibbard study demonstrated that PAM scores increased 4.6 pts for the intervention group compared to just 1.4 points for the control group, demonstrating that the tool improved the patients' ability to manage their conditions.

"Tailoring support to an individual's level of activation and self-management ability allows coaches to address the competencies that drive the behaviors critical to better health and the more efficient use of healthcare resources," said Chris Delaney, Insignia's Chief Executive Officer. "This study clearly demonstrates the benefits of this patient-centric model."

Funded by the Health Industry Forum at Brandeis University, the study and its practical applications will be discussed on September 21-22 at DMAA: The Care Continuum Alliance's Forum 09 conference in San Diego. The American Journal of Managed Care is an independent, peer-reviewed publication dedicated to disseminating clinical information to managed care physicians, clinical decision makers and other healthcare professionals. For a copy of the study, go to http://www.ajmc.com.

About LifeMasters Supported SelfCare, Inc.
LifeMasters Supported SelfCare, Inc. is a leading provider of health improvement and condition management programs and services that create health partnerships among individuals and their physicians. The programs improve the quality of care for populations with risk factors and chronic conditions and reduce healthcare cost trends for the nation's leading health plans, employers, retirement systems, labor unions/trusts and governmental organizations. LifeMasters offers programs for individuals with diabetes, congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, hypertension, asthma, cancer, depression and musculo-skeletal pain. LifeMasters' programs are holistically focused, support co-morbidities like depression, and facilitate lifestyle changes such as smoking cessation and weight loss. LifeMasters is accredited by the National Committee for Quality Assurance (NCQA) and URAC. More information can be found at http://innovation.lifemasters.com.

About Insignia Health
Insigna Health supports organizations and their efforts to help individuals develop the behaviors that are crucial to becoming more active and successful managers of their health and healthcare. This support is anchored by the Patient Activation Measure™ assessment. Insignia's tailored products leverage a wealth of self-management insight to help individuals master new positive behaviors that are realistic given a level of activation. Research has shown consistently that with increased activation comes better health and the more effective and efficient use of healthcare resources. More information can be found at http://www.insigniahealth.com.